Shelby County.JAX0178.pdf

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Attached to
Release State Use/Facilities for Persons with Severe Disabilities IL|24-416CMS-BOSS4-P-66298
Contract number
24-416CMS-BOSS4-P-66298
Issued by
Illinois

About this file

Written by GovTribe AI ·

This is a Purchase Request form from the Illinois Department of Corrections for Jacksonville Correctional Center, dated 08/20/2025, with the requisition number 726JAX0178. The primary vendor listed for this purchase is Shelby County, though no specific contact details are provided beyond the vendor name.

The purchase request is for trash bags, specifically 50 cases of 33-gallon trash bags and 50 cases of 55-gallon trash bags. The total cost for the order is $5,217.50, with the 33-gallon bags priced at $54.08 per case (total $2,704.00) and the 55-gallon bags priced at $50.27 per case (total $2,513.50). The justification for the purchase is that the stock of trash bags is running low for facility needs. The document indicates this is a purchase under $2,000, though the total exceeds that amount. The request was initiated by Michael Martin, approved by Tracy Flowers and Rich Stempinski, and is marked for the Warehouse/Dietary function code.

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Distribution: Business Office Printed on Recycled Paper DOC 0143 (Rev. 3/2021)

ILLINOIS DEPARTMENT OF CORRECTIONS

Purchase Request

Facility / Division OFD / Req. # Object Code Date

Item Requested Vendor #1 Vendor #2 Vendor #3 D. O.

Code Description of Item(s) Qty. Unit

Size Unit Price Total Price Unit Price Total Price Unit Price Total Price

NOTE: This form is for purchases under $2,000.

Freight

Total

Justification:

Item Requested Vendor #4 Vendor #5 Vendor #6 D. O.

Code Description of Item(s) Qty. Unit

Size Unit Price Total Price Unit Price Total Price Unit Price Total Price

NOTE: This form is for purchases under $2,000.

Freight

Total

Justification:

Distribution: Business Office Printed on Recycled Paper DOC 0143 (Rev. 3/2021)

Vendor #1 Vendor #2 Vendor #3 Name:

Vendor #:

Address:

Phone #:

Email Address:

Contact Person:

Comments:

Awarded Written Verbal Awarded Written Verbal Awarded Written Verbal

Vendor #4 Vendor #5 Vendor #6 Name:

Vendor #:

Address:

Phone #:

Email Address:

Contact Person:

Comments:

Awarded Written Verbal Awarded Written Verbal Awarded Written Verbal

Awarded Vendor’s FEIN#: If not low bidder, state justification in “comments.”

Ordering Procedure (check one): Mail OFD FAX OFD Contract Order #

Requester will phone in: Other:

Name of Contact

Deliver to:

Facility/Division

Department

Attention (Print Name)

Address

City State Zip Code

Requested by:

Print Name Extension Approved by:

Department Head’s Signature Date

Business Administrator’s Signature Date

Chief Administrator’s Signature Date

Check Function Code 01 Satellite #1 04 Security 07 Warehouse/Dietary 02 Satellite #2 05 Programs 08 Clothing 03 Medical 06 Maintenance 09 Administration

Item Requested
Freight
Item Requested
Freight
Check Function Code
01 Satellite #1
04 Security
07 Warehouse/Dietary
02 Satellite #2
05 Programs
08 Clothing
03 Medical
06 Maintenance
09 Administration
Facility Division: Jacksonville CC
OFD Req: 7126JAX0178
Object Code: 1391
Date: 08/20/2025
D O CodeRow1:
Description of ItemsRow1:
QtyRow1:
Unit SizeRow1:
Unit PriceRow1_2:
Total PriceRow1_2: 0
Unit PriceRow1_3:
Total PriceRow1_3: 0
D O CodeRow2:
Description of ItemsRow2:
QtyRow2:
Unit SizeRow2:
Total PriceRow2: 0
Unit PriceRow2_2:
Total PriceRow2_2: 0
Unit PriceRow2_3:
Total PriceRow2_3: 0
D O CodeRow3:
Description of ItemsRow3:
QtyRow3:
Unit SizeRow3:
Total PriceRow3: 0
Unit PriceRow3_2:
Total PriceRow3_2: 0
Unit PriceRow3_3:
Total PriceRow3_3: 0
D O CodeRow4:
Description of ItemsRow4:
QtyRow4:
Unit SizeRow4:
Total PriceRow4: 0
Unit PriceRow4_2:
Total PriceRow4_2: 0
Unit PriceRow4_3:
Total PriceRow4_3: 0
D O CodeRow5:
Description of ItemsRow5: 33 gallon trash bags
QtyRow5: 50
Unit SizeRow5: cs
Total PriceRow5: 2704
Unit PriceRow5_2:
Total PriceRow5_2: 0
Unit PriceRow5_3:
Total PriceRow5_3: 0
D O CodeRow6:
Description of ItemsRow6: 55 gallon trash bags
QtyRow6: 50
Unit SizeRow6: cs
Total PriceRow6: 2513.5
Unit PriceRow6_2:
Total PriceRow6_2: 0
Unit PriceRow6_3:
Total PriceRow6_3: 0
D O CodeRow7:
Description of ItemsRow7:
QtyRow7:
Unit SizeRow7:
Unit PriceRow7:
Total PriceRow7: 0
Unit PriceRow7_2:
Total PriceRow7_2: 0
Unit PriceRow7_3:
Total PriceRow7_3: 0
D O CodeRow8:
Description of ItemsRow8:
QtyRow8:
Unit SizeRow8:
Unit PriceRow8:
Total PriceRow8: 0
Unit PriceRow8_2:
Total PriceRow8_2: 0
Unit PriceRow8_3:
Total PriceRow8_3: 0
D O CodeRow9:
Description of ItemsRow9:
QtyRow9:
Unit SizeRow9:
Unit PriceRow9:
Total PriceRow9: 0
Unit PriceRow9_2:
Total PriceRow9_2: 0
Unit PriceRow9_3:
Total PriceRow9_3: 0
D O CodeRow10:
Description of ItemsRow10:
QtyRow10:
Unit SizeRow10:
Unit PriceRow10:
Total PriceRow10: 0
Unit PriceRow10_2:
Total PriceRow10_2: 0
Unit PriceRow10_3:
Total PriceRow10_3: 0
Justification 1: Stock running low for facility needs for trash bags.
D O CodeRow1_2:
Description of ItemsRow1_2:
QtyRow1_2:
Unit SizeRow1_2:
Unit PriceRow1_4:
Total PriceRow1_4: 0
Unit PriceRow1_5:
Total PriceRow1_5: 0
Unit PriceRow1_6:
Total PriceRow1_6: 0
D O CodeRow2_2:
Description of ItemsRow2_2:
QtyRow2_2:
Unit SizeRow2_2:
Unit PriceRow2_4:
Total PriceRow2_4: 0
Unit PriceRow2_5:
Total PriceRow2_5: 0
Unit PriceRow2_6:
Total PriceRow2_6: 0
D O CodeRow3_2:
Description of ItemsRow3_2:
QtyRow3_2:
Unit SizeRow3_2:
Unit PriceRow3_4:
Total PriceRow3_4: 0
Unit PriceRow3_5:
Total PriceRow3_5: 0
Unit PriceRow3_6:
Total PriceRow3_6: 0
D O CodeRow4_2:
Description of ItemsRow4_2:
QtyRow4_2:
Unit SizeRow4_2:
Unit PriceRow4_4:
Total PriceRow4_4: 0
Unit PriceRow4_5:
Total PriceRow4_5: 0
Unit PriceRow4_6:
Total PriceRow4_6: 0
D O CodeRow5_2:
Description of ItemsRow5_2:
QtyRow5_2:
Unit SizeRow5_2:
Unit PriceRow5_4:
Total PriceRow5_4: 0
Unit PriceRow5_5:
Total PriceRow5_5: 0
Unit PriceRow5_6:
Total PriceRow5_6: 0
D O CodeRow6_2:
Description of ItemsRow6_2:
QtyRow6_2:
Unit SizeRow6_2:
Unit PriceRow6_4:
Total PriceRow6_4: 0
Unit PriceRow6_5:
Total PriceRow6_5: 0
Unit PriceRow6_6:
Total PriceRow6_6: 0
D O CodeRow7_2:
Description of ItemsRow7_2:
QtyRow7_2:
Unit SizeRow7_2:
Unit PriceRow7_4:
Total PriceRow7_4: 0
Unit PriceRow7_5:
Total PriceRow7_5: 0
Unit PriceRow7_6:
Total PriceRow7_6: 0
D O CodeRow8_2:
Description of ItemsRow8_2:
QtyRow8_2:
Unit SizeRow8_2:
Unit PriceRow8_4:
Total PriceRow8_4: 0
Unit PriceRow8_5:
Total PriceRow8_5: 0
Unit PriceRow8_6:
Total PriceRow8_6: 0
D O CodeRow9_2:
Description of ItemsRow9_2:
QtyRow9_2:
Unit SizeRow9_2:
Unit PriceRow9_4:
Total PriceRow9_4: 0
Unit PriceRow9_5:
Total PriceRow9_5: 0
Unit PriceRow9_6:
Total PriceRow9_6: 0
D O CodeRow10_2:
Description of ItemsRow10_2:
QtyRow10_2:
Unit SizeRow10_2:
Unit PriceRow10_4:
Total PriceRow10_4: 0
Unit PriceRow10_5:
Total PriceRow10_5: 0
Unit PriceRow10_6:
Total PriceRow10_6: 0
1: Shelby County
2:
1_2:
2_2:
1_3:
2_3:
1_4:
2_4:
3:
1_5:
2_5:
3_2:
1_6:
2_6:
3_3:
undefined:
undefined_2:
undefined_3:
1_7:
2_7:
1_8:
2_8:
1_9:
2_9:
Awarded: Off
Written: Off
Verbal: Off
Awarded_2: Off
Written_2: Off
Verbal_2: Off
Awarded_3: Off
Written_3: Off
Verbal_3: Off
1_13:
2_13:
1_14:
2_14:
1_15:
2_15:
1_16:
2_16:
3_4:
1_17:
2_17:
3_5:
1_18:
2_18:
3_6:
undefined_4:
undefined_5:
undefined_6:
1_19:
2_19:
1_20:
2_20:
1_21:
2_21:
Awarded_4: Off
Written_4: Off
Verbal_4: Off
Awarded_5: Off
Written_5: Off
Verbal_5: Off
Awarded_6: Off
Written_6: Off
Verbal_6: Off
Awarded Vendors FEIN:
Mail OFD: Off
FAX OFD: Off
Contract Order: Off
undefined_7:
Name of Contact:
Other: Off
undefined_8:
FacilityDivision:
Print Name: Michael Martin
Extension: 347
Department:
Attention Print Name:
Date_2:
Address:
City:
State:
Zip Code:
2025-08-20T14:11:54-0500
Tracy Flowers
Date_3: 08/20/2025
04 Security: Off
05 Programs: Off
06 Maintenance: Off
2025-08-20T15:12:32-0500
Rich Stempinski
Date_4: 08/20/2025
01 Satellite 1: Off
02 Satellite 2: Off
03 Medical: Off
07 WarehouseDietary: Off
08 Clothing: Off
09 Administration: Off
Justification 1_2:
Unit PriceRow2:
Unit PriceRow3:
Unit PriceRow4:
Unit PriceRow5: 54.08
Unit PriceRow6: 50.27
Total PriceRow1: 0
Unit PriceRow1:
Freight 3:
Freight 2:
Freight 1:
Freight 4:
Freight 5:
Freight 6:
Total Price V1: 5217.5
Total Price V2: 0
Total Price V3: 0
Total Price V4: 0
Total Price V5: 0
Total Price V6: 0
Check Box1: Off

File details come from the government source that posted it. Updated .